Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
Records 1-12 (of 12 Records) |
Query Trace: Olivari BS[original query] |
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Evaluating cognitive impairment in a large health care system: The cognition in primary care program
Gaster B , Suchsland MZ , Fitzpatrick AL , Liao JM , Belza B , Hsu AP , McKiddy S , Park C , Olivari BS , Singh AP , Raetz J . J Alzheimers Dis 2024 BACKGROUND: The prevalence of Alzheimer's disease and related disorders (ADRD) is rising. Primary care providers (PCPs) will increasingly be required to play a role in its detection but lack the training to do so. OBJECTIVE: To develop a model for cognitive evaluation which is feasible in primary care and evaluate its implementation in a large health system. METHODS: The Cognition in Primary Care Program consists of web-based training together with integrated tools built into the electronic record. We implemented the program among PCPs at 14 clinics in a large health system. We (1) surveyed PCPs to assess the impact of training on their confidence to evaluate cognition, (2) measured the number of cognitive assessments they performed, and (3) tracked the number of patients diagnosed with mild cognitive impairment (MCI). RESULTS: Thirty-nine PCPs completed the training which covered how to evaluate cognition. Survey response rate from those PCPs was 74%. Six months after the end of the training, they reported confidence in assessing cognition (mean 4.6 on 5-point scale). Cognitive assessments documented in the health record increased from 0.8 per month before the training to 2.5 in the six months after the training. Patients who were newly diagnosed with MCI increased from 4.2 per month before the training to 6.0 per month in the six months after the training. CONCLUSIONS: This model for cognitive evaluation in a large health system was shown to increase cognitive testing and increase diagnoses of MCI. Such improvements are essential for the timely detection of ADRD. |
Racial and ethnic differences in subjective cognitive decline - United States, 2015-2020
Wooten KG , McGuire LC , Olivari BS , Jackson EMJ , Croft JB . MMWR Morb Mortal Wkly Rep 2023 72 (10) 249-255 Subjective cognitive decline (SCD), the self-reported experience of worsening or more frequent memory loss or confusion, might be a symptom of early-stage dementia or future serious cognitive decline such as Alzheimer disease* or a related dementia (ADRD) (1). Established modifiable risk factors for ADRD include high blood pressure, inadequate physical activity, obesity, diabetes, depression, current cigarette smoking, and hearing loss (2). An estimated 6.5 million persons aged ≥65 years in the United States live with Alzheimer disease, the most common dementia (1). This number is projected to double by 2060, with the largest increase among non-Hispanic Black or African American (Black), and Hispanic or Latino (Hispanic) adults (1,3). Using data from the Behavioral Risk Factor Surveillance System (BRFSS), CDC assessed racial and ethnic, select demographic, and geographical differences in SCD prevalence, and prevalence of health care professional conversations among those reporting SCD. The age-adjusted prevalence of SCD during 2015-2020 was 9.6% among adults aged ≥45 years (5.0% of Asian or Pacific Islander [A/PI] adults, 9.3% of non-Hispanic White [White] adults, 10.1% of Black adults, 11.4% of Hispanic adults, and 16.7% of non-Hispanic American Indian or Alaska Native [AI/AN] adults). College education was associated with a lower prevalence of SCD among all racial and ethnic groups. Only 47.3% of adults with SCD reported that they had discussed confusion or memory loss with a health care professional. Discussing changes in cognition with a physician can allow for the identification of potentially treatable conditions, early detection of dementia, promotion of dementia risk reduction behaviors, and establishing a treatment or care plan to help adults remain healthy and independent for as long as possible. |
Prevalence and characteristics of arthritis among caregivers - 17 states, 2017 and 2019
Jackson EMJ , Omura JD , Boring MA , Odom EL , Foster AL , Olivari BS , McGuire LC , Croft JB . MMWR Morb Mortal Wkly Rep 2022 71 (44) 1389-1395 Caregiving provides numerous benefits to both caregivers and care recipients; however, it can also negatively affect caregivers' mental and physical health (1-4), and caregiving tasks often require physical exertion (1). Approximately 44% of adults with arthritis report limitations attributable to arthritis, including trouble doing daily activities (5). These limitations might affect caregivers' ability to provide care, but little is known about arthritis among caregivers. To assess arthritis among caregivers of a family member or friend, CDC examined data from 17 states that administered both the arthritis and caregiving modules as part of the Behavioral Risk Factor Surveillance System (BRFSS) in either 2017 or 2019. Approximately one in five adults (20.6%) was a caregiver. Prevalence of arthritis was higher among caregivers (35.1%) than noncaregivers (24.5%). Compared with caregivers without arthritis, those with arthritis provided similar types of care and were more likely to have provided care for ≥5 years and for ≥40 hours per week. In addition, higher proportions of caregivers with arthritis reported disabilities compared with those without arthritis, including mobility issues (38.0% versus 7.3%). Arthritis among caregivers might affect their own health as well as the care they can provide. Caregivers can discuss their arthritis and related limitations with a health care professional to identify ways to increase their physical activity and participation in lifestyle management programs.* Such interventions might ease arthritis pain and related limitations and might support them in their ongoing caregiving role. Public health professionals can implement strategies to support caregivers throughout the caregiving process.(†). |
Modifiable risk factors for Alzheimer disease and related dementias among adults aged 45 years - United States, 2019
Omura JD , McGuire LC , Patel R , Baumgart M , Lamb R , Jeffers EM , Olivari BS , Croft JB , Thomas CW , Hacker K . MMWR Morb Mortal Wkly Rep 2022 71 (20) 680-685 Alzheimer disease,* the most common cause of dementia, affects an estimated 6.5 million persons aged ≥65 years in the United States (1). A growing body of evidence has identified potential modifiable risk factors for Alzheimer disease and related dementias (ADRD) (1-3). In 2021, the National Plan to Address Alzheimer's Disease (National Plan) introduced a new goal to "accelerate action to promote healthy aging and reduce risk factors for Alzheimer's disease and related dementias" to help delay onset or slow the progression of ADRD (3). To assess the status of eight potential modifiable risk factors (i.e., high blood pressure, not meeting the aerobic physical activity guideline, obesity, diabetes, depression, current cigarette smoking, hearing loss, and binge drinking), investigators analyzed data from the cognitive decline module that was administered to adults aged ≥45 years in 31 states and the District of Columbia (DC)(†) in the 2019 Behavioral Risk Factor Surveillance System (BRFSS) survey. Among the risk factors, prevalence was highest for high blood pressure (49.9%) and lowest for binge drinking (10.3%) and varied by selected demographic characteristics. Adults with subjective cognitive decline (SCD),(§) an early indicator of possible future ADRD (4), were more likely to report four or more risk factors than were those without SCD (34.3% versus 13.1%). Prevalence of SCD was 11.3% overall and increased from 3.9% among adults with no risk factors to 25.0% among those with four or more risk factors. Implementing evidence-based strategies to address modifiable risk factors can help achieve the National Plan's new goal to reduce risk for ADRD while promoting health aging.(¶)(,)*. |
Early-onset dementia among privately-insured adults with and without congenital heart defects in the United States, 2015-2017
Downing KF , Oster ME , Olivari BS , Farr SL . Int J Cardiol 2022 358 34-38 Adults with CHD were 2× as likely as those without CHD to have early-onset dementia. | | • | Early-onset dementia was associated with CHD among males but not females. | | • | Early-onset dementia was associated with CHD in both age groups (45–54 & 55–64 yrs). | | • | Results were similar comparing those with non-severe CHD to no CHD. |
Improving brain health for populations disproportionately affected by Alzheimer's disease and related dementias
Olivari BS , Jeffers EM , Tang KW , McGuire LC . Clin Gerontol 2022 46 (2) 1-5 Promoting and maintaining brain health for older adults is one of the greatest challenges facing the public health community in the United States. This will require the public health community to take steps to reduce disparities in brain health across disproportionately impacted communities. Although some levels of change in the brain processes, like slower processing speeds, trouble with multitasking or even increases in knowledge, are expected as people grow older, significant memory loss and other symptoms of dementia are not normal or inevitable (Centers for Disease Control and Prevention, Citation2021). Dementia is a general term used to describe problems with thinking and memory that are severe enough to interfere with a person’s daily life. Alzheimer’s disease is the most common form of dementia, accounting for about two-thirds of all cases, while other common forms of dementia such as cerebrovascular, Lewy body, frontotemporal or a combination of multiple co-occurring forms together make up a constellation commonly referred to as Alzheimer’s disease and related dementias (ADRD) (Alzheimer’s Association, Citation2021). Today, it is estimated that over 6 million people in the United States are living with ADRD (Alzheimer’s Association, Citation2021). |
Stroke Hospitalizations Before and During COVID-19 Pandemic Among Medicare Beneficiaries in the United States.
Yang Q , Tong X , Coleman King S , Olivari BS , Merritt RK . Stroke 2021 52 (11) 3586-3601 BACKGROUND AND PURPOSE: Emergency department visits and hospitalizations for stroke declined significantly following declaration of coronavirus disease 2019 (COVID-19) as a national emergency on March 13, 2020, in the United States. This study examined trends in hospitalizations for stroke among Medicare fee-for-service beneficiaries aged ≥65 years and compared characteristics of stroke patients during COVID-19 pandemic to comparable weeks in the preceding year (2019). METHODS: For trend analysis, we examined stroke hospitalizations from week 1 in 2019 through week 44 in 2020. For comparison of patient characteristics, we estimated percent reduction in weekly stroke hospitalizations from 2019 to 2020 during weeks 10 through 23 and during weeks 24 through 44 by age, sex, race/ethnicity, and state. RESULTS: Compared to weekly numbers of hospitalizations for stroke reported during 2019, stroke hospitalizations in 2020 decreased sharply during weeks 10 through 15 (March 1-April 11), began increasing during weeks 16 through 23, and remained at a level lower than the same weeks in 2019 from weeks 24 through 44 (June 7-October 31). During weeks 10 through 23, stroke hospitalizations decreased by 22.3% (95% CI, 21.4%-23.1%) in 2020 compared with same period in 2019; during weeks 24 through 44, they decreased by 12.1% (95% CI, 11.2%-12.9%). The magnitude of reduction increased with age but similar between men and women and among different race/ethnicity groups. Reductions in stroke hospitalizations between weeks 10 through 23 varied by state ranging from 0.0% (95% CI, -16.0%-1.7%) in New Hampshire to 36.2% (95% CI, 24.8%-46.7%) in Montana. CONCLUSIONS: One-in-5 fewer stroke hospitalizations among Medicare fee-for-service beneficiaries occurred during initial weeks of the COVID-19 pandemic (March 1-June 6) and weekly stroke hospitalizations remained at a lower than expected level from June 7 to October 31 in 2020 compared with 2019. Changes in stroke hospitalizations varied substantially by state. |
Cognitive Decline and Dementia Risk Reduction: Promoting Healthy Lifestyles and Blood Pressure Control
Barrett JP , Olivari BS , Price AB , Taylor CA . Am J Prev Med 2021 61 (3) e157-e160 There is an immediate need to increase public health focus on the prevention of Alzheimer disease and related dementias (ADRD). The population upward shift in age drives this imperative, with 1 in 5 Americans expected to be aged ≥65 years by 2030.1 In 2020, there were an estimated 5.8 million people aged ≥65 years with ADRD in the U.S., and as the population ages, the number of people with ADRD is expected to reach 8.4 million by 2030 and 13.8 million by 2050.2 Research shows that the modifiable risk factors for ADRD are, for the most part, the same risks associated with cardiovascular disease.2, 3, 4, 5, 6, 7 Similar to heart disease, ADRD takes years to develop, presenting an opportunity for risk reduction as research continues for improved symptomatic treatments and disease-modifying agents. Although the growing evidence supporting risk-factor modification for ADRD is encouraging, with the control of midlife hypertension as an important example, the evidence supporting lifestyle interventions for cardiac diseases is consistently high.2,3,6, 7, 8, 9 There are numerous examples of successful heart health programs, and efforts to support brain health should complement the existing initiatives rather than compete for limited public health resources. In recent years, excellent lifestyle medicine and brain health resources have been developed to support the development of public health programs for the prevention of cognitive impairment and the care of ADRD.10, 11, 12, 13, 14 The time is now to focus on brain health, building on ongoing epidemiologic and encouraging clinical research. In addressing this crisis, 1 key theme to understand is “What's good for the heart, is good for the brain.” |
Population measures of subjective cognitive decline: A means of advancing public health policy to address cognitive health
Olivari BS , Baumgart M , Taylor CA , McGuire LC . Alzheimers Dement (N Y) 2021 7 (1) e12142 Subjective cognitive decline (SCD) is receiving increasing attention as studies have suggested that SCD status is associated with risk of future cognitive decline and dementia. Population-based measures of SCD can be extremely useful to the public health community, health-care providers, researchers, and policymakers. A large population-based SCD measure now exists through the state-based Behavioral Risk Factor Surveillance System (BRFSS). All 50 states have included the cognitive decline module, which asks about SCD, to their BRFSS survey one or more times. Population measures of SCD can aid researchers in designing clinical studies by better estimating the populations that may be at risk for more severe cognitive decline based on their SCD status to ensure that the optimal groups are targeted. Population-level estimates of SCD can also help to inform health-care providers' decisions about initiating cognitive assessments, managing other conditions among those with memory problems, and identifying the needs of caregivers. |
The public health road map to respond to the growing dementia crisis
Olivari BS , French ME , McGuire LC . Innov Aging 2020 4 (1) igz043 As the proportion of older adults in the United States is projected to increase dramatically in the coming decades, it is imperative that public health address and maintain the cognitive health of this growing population. More than 5 million Americans live with Alzheimer's disease and related dementias (ADRD) today, and this number is projected to more than double by 2050. The public health community must be proactive in outlining the response to this growing crisis. Promoting cognitive decline risk reduction, early detection and diagnosis, and increasing the use and availability of timely data are critical components of this response. To prepare state, local, and tribal organizations, CDC and the Alzheimer's Association have developed a series of Road Maps that chart the public health response to dementia. Since the initial Healthy Brain Initiative (HBI) Road Map release in 2007, the Road Map has undergone two new iterations, with the most recent version, The HBI's State and Local Public Health Partnerships to Address Dementia: The 2018-2023 Road Map, released in late 2018. Over the past several years, significant advances were made in the science of risk reduction and early detection of ADRD. As a result, the public health response requires a life-course approach that focuses on reducing risk and identifying memory issues earlier to improve health outcomes. The most recent Road Map was revised to accommodate these strides in the science and to effect change at the policy, systems, and environment levels. The 2018-2023 Road Map identifies 25 actions that state and local public health agencies and their partners can implement to promote cognitive health and address cognitive impairment and the needs of caregivers. The actions are categorized into four traditional domains of public health, and the Road Map can help public health and its partners chart a course for a dementia-prepared future. |
Characteristics and health status of informal unpaid caregivers - 44 states, District of Columbia, and Puerto Rico, 2015-2017
Edwards VJ , Bouldin ED , Taylor CA , Olivari BS , McGuire LC . MMWR Morb Mortal Wkly Rep 2020 69 (7) 183-188 In 2015, an estimated 17.7 million U.S. persons were informal caregivers who provided substantial services through in-home, unpaid assistance to their family members and friends (1). Caregiving can have many benefits, such as enhancing the bond between caregiver and recipient, but it can also place an emotional and physical strain on caregivers, leading to higher rates of depression, lower quality of life, and poorer overall health (2). As the U.S. population continues to age (3), the need for informal caregivers will likely increase. However, little nationally representative information on prevalence of caregivers is available. This study examined demographic characteristics and health status of informal caregivers from 44 states,* the District of Columbia (DC), and Puerto Rico, based on data from the Behavioral Risk Factor Surveillance System (BRFSS) collected during 2015-2017. Overall, approximately one in five adults reported that they had provided care to a family member or friend in the preceding 30 days. Fifty-eight percent of caregivers were women, and a majority were non-Hispanic white, with at least some college education, and married or living with a partner. Across all states, 19.2% of caregivers reported being in fair or poor health, although significant state-to-state variation occurred. Caregivers provide important support to family members, friends, and the health care system and might compromise their own health to provide this support (1,2). Better understanding of caregivers and the challenges they face could inform implementation of improvements in support systems that could enhance not only the health of the caregiver, but that of the care recipient as well. For example, additional data regarding demographics at the state level might aid in more effective planning and support of caregivers with evidence-based programs and assistance (https://www.cdc.gov/aging/publications/features/caring-for-yourself.html). |
CDC Grand Rounds: Promoting well-being and independence in older adults
Olivari BS , Baumgart M , Lock SL , Whiting CG , Taylor CA , Iskander J , Thorpe P , McGuire LC . MMWR Morb Mortal Wkly Rep 2018 67 (37) 1036-1039 Healthy aging is not merely the absence of disease or disability, but requires physical and mental health and ongoing social engagement (1). As the average U.S. life expectancy increases, recognition that public health can play a vital role in promoting healthy, successful aging even in the face of increased prevalence of chronic diseases, including types of dementia, among older adults (i.e., aged >/=65 years) has grown. Furthermore, actively engaging adults in prevention and wellness along with involving their caregivers (i.e., the family and friends of older adults who provide them with unpaid and informal support and services) can serve to prevent or delay the onset of physical disabilities and cognitive decline. Adults often are reluctant to discuss their concerns about worsening memory with their health care providers although such discussions can lead to earlier diagnosis and better care, planning, and support. As advances in public health and health care have helped increase life expectancy, public health professionals and health care providers have the opportunity to improve the quality of life for older adults and their caregivers and reduce the burdens associated with aging. |
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- Page last updated:Jan 27, 2025
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